AI Summary
A 76-year-old woman with asymmetric chorea and no brain lesions has an increased striatal metabolism. She has an elevated anti-streptolysin O titer, indicating a possible Sydenham chorea. Treatment with clarithromycin and immunomodulatory medication improves her movement disorder.
A 76-year-old woman presented with asymmetric chorea (Video 1) that has evolved within the past 6 weeks before admission. The cMRI showed no brain lesions apart from slight cerebral small vessel disease (Figure, A and B). The 18F-FDG-PET revealed an increased striatal metabolism (Figure, C–F) that has been reported in young patients with Sydenham chorea after Streptococcus infections.1,2 Additional laboratory tests yield an elevated anti–streptolysin O (ASO) titer with 1352 IU/mL (ref < 200 IU/mL). Suspecting a Sydenham chorea, we initiated a treatment with the antibiotic clarithromycin combined with immunomodulatory treatment (methylprednisolone and intravenous immunoglobulins) leading to significant improvement of the movement disorder (Video 1).